Panel 15

The Ebola epidemic in West Africa: Caregivers’ disease and game changer

Panel organiser: Geir Gunnlaugsson, University of Iceland, Iceland

The Ebola epidemic in West Africa has been called a game-changer in global health. It exposed weakness in the international preparedness to health security threat from its ground zero in a small and isolated village in Guinea. From there it spread rapidly to neighbouring countries with Guinea, Sierra Leone, and Liberia the ones most affected by the epidemic. The epidemic was also perceived as a threat to health all over the world. On the ground, Ebola was referred to as caregivers disease, indicating the high transmission rate and subsequent mortality in Ebola of those who cared for patients, healthcare workers and community members alike, in particular women.

The overall aim of the panel is to identify, discern and synthesize challenges and opportunities for preparedness, prevention, and containment of global health threats such as the Ebola virus disease (EVD) epidemic in West Africa. We aim to bring together an international and inter-disciplinary group of researchers and practitioners to focus on the social, economic, political and cultural realities of the Ebola epidemic that can either contribute to preparedness, prevention and containment of epidemics, such as EVD, or facilitate its spread. Papers are invited that address the manifold challenges of the Ebola epidemic and lessons learned, including human rights violations and the gender dimensions. The impact of Ebola on caregivers, including women as a group and professionals, is of particular concern both during and after the epidemic. How has the epidemic affected women’s access to and use of health care facilities during pregnancy and birth? Has the international community a role to play to strengthen health systems, or is that a national responsibility? How can donors and recipients collaborate to improve preparedness, prevention, and containment of future epidemics and health threats such as Ebola?

Approved abstracts Panel 15

1. Ebola: the politics of mistrust

Author: Abdoulaye Wotem Somparé awsompare@gmail.com
The paper will be presented by Hamadou Boiro at the conference

One of the most striking aspects of the recent epidemics of Ebola in West Africa, and especially in Guinea, was the abundance of attitudes of reticence and resistance of urban and rural communities, determined not to respect the recommendations of the authorities, or to impede their action even through violence. Resistances were mostly based on the idea that the epidemics did not exist and was the result of a conspiracy organized by the State against with the help of the International Institutions. This epidemics was the occasion to discover and analyse a widespread mistrust towards the authorities, perceived, according to Bayart’s description (2009) , as corrupted and uninterested in the well-being of local people . Such attitudes were thrived by a political context of bipolarization, in which some leaders of the opposition party tended to make an instrumental use of rumours, in order to weaken the support to the Government .After a year of fieldwork on resistances as a consultant of WHO, I will try to present the historical and socio-political reasons of the common feeling of mistrust, deception and abandon, directed both towards the State and local political and moral authorities, perceived as partners of the Government and increasingly delegitimized. I will also show how the epidemics has been the occasion, for many unheeded communities , to finally express their needs and claims to the authorities. Finally, I will analyse how Ebola has disrupted the social ties and hierarchies of many rural areas, eroding gerontocracy to the advantage of new social actors, taking part of networks relating villages and towns, able to provide information, control rumours and influence public opinion.

2. The challenges of EVD in Guinea: the puzzle of monitoring contacts

During the Ebola epidemic in Guinea, monitoring the whereabouts of contacts was a major task and an obstacle to interrupt the infection chain. After the death of a woman who tested positive for Ebola Virus Disease (EDV) in one village in Gberika Forecariah District, a list of one hundred contacts with her was established. Among them was a friend who undid the braids of the deceased woman who fled the village when identified as a contact. Despite active search for more than 42 days, she was never found. The main objective of this presentation is to document and analyze this case of lost contact in the village in order to illuminate the challenges that faced the Ebola workers. To find the woman several approaches and strategies were put in place, including use of force when her husband and parents were arrested and socio-anthropological approach that applied kinship networks, women’s networks, and collaboration with leaders. The results highlight that when communities decide to hide a person that person cannot be found. Underneath, there was competition between members of the Ebola team to find the lost woman. In Guinea there are even villages local authorities can not access, such as this village. Even the Prime Minister came to talk to the population that added to politicization of the Ebola response. The population became more afraid of the team that worked to eradicate Ebola than the disease itself. A key recommendation is to establish community engagement that builds on existing traditional networks in which the population has trust. Further, with proper community involvement stigmatization of Ebola survivors can been fought.

3. Ebola preparedness in Guinea-Bissau: frontline healthcare workers

The Ebola epidemic in West Africa has exposed weakness in international preparedness to health security threats with implications for the whole world. Guinea-Bissau has since the start of the epidemic been exposed to the risk of Ebola exposure through cross-border transmission from Guinea (Conakry) with which it shares a porous 400 km long border, and daily contacts through fishermen. Here the aim is to describe and analyse knowledge, practice and attitudes of frontline healthcare workers in Guinea-Bissau vis-à-vis Ebola preparedness for an eventual outbreak in the country. Qualitative interviews were held in 2015 and 2016. Over-all results indicate that in a country with a fragile health system, as Guinea-Bissau, it is difficult to stick to high-level preparedness for months. With on-going flare-ups of Ebola in the neighbouring country, Guinea-Bissau needs strong global support, both in preparedness for an outbreak, but also how to cope in case Ebola is diagnosed within the country.

In the early phase of the Ebola Virus Disease (EVD) epidemic in Guinea, Liberia and Sierra Leone, correct diagnosis was difficult. The disease was new in the area, and frontline health workers were unaware of its recent introduction. Symptoms of EVD are also similar to commonly occurring diseases, for example malaria, typhoid and cholera, which contributed to delayed recognition of an epidemic in the making. The population had no prior experience of the new disease that increasingly spread death and despair. Misguided preventive activities and political interventions contributed to population mistrust and violence against health workers and others fighting the epidemic. In former cholera epidemics in Europe and North America where mortality rates exceeded 50% similar popular reactions are documented. The aim of this presentation is to explore local responses to new threatening diseases such as cholera and Ebola. Are there any lessons that can be learned from cholera epidemics of importance for prevention of EVD? The data presented rests on qualitative and quantitative research conducted in Biombo Region, Guinea-Bissau, during cholera epidemics in the 1990s as well as interviews on Ebola with villagers in the region in 2015 and 2016. The 1994 cholera epidemic in Biombo Region prompted ritual practices that aimed to curtail the epidemic. The population observed that most of those who sought treatment were cured, although mortality levels varied greatly between the health centers. Nurses working at a health center with high mortality rates were victims of violence and accusations of sorcery. Likewise, guidelines given by local authorities for disinfection of cadavers deceased of cholera and a quick burial were not followed by all. Similar rituals have been performed to prevent eventual Ebola epidemic as in the 1990s to prevent transmission of cholera, and traditional authorities prohibited certain burial rituals for a while.